27years
G1
GA : 28w 2d (by sono 8w :28w 3d )
Fondal height : 24 cm
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BPD :24W 3D
AC : 22 W
FL : 21 W
AFI : NL
Severe IUGR
 BPP: breath:0
AF:2
tone:2
 Doppler : increased Umbilical artery RI
 AC < 10% and EFW < 10% : SUSPECTED TO
IUGR
 AC < 10% and EFW > 10% : at risk to IUGR
‫‪27years ,G1‬‬
‫) ‪GA : 28w 2d (by sono 8w :28w 3d‬‬
‫‪C.C : fundal height 24 ‬‬
‫‪cm‬‬
‫بیمار مورد شناخته شده تاالسمی اینترمدیا که ‪ 10‬سال قبل اسپلنکتومی‬‫شده است‬
‫‪2‬هفته بعد از اسپلنکتومی دچار ترومبوفلبیت عروق کبدی می شود و‬‫تحت درمان با هپارین و وارفارین تا ‪ 1‬ماه پس از ترخیص قرار میگیرد‬
‫از ‪ 10‬سال قبل تا کنون آسپیرین مصرف می کند‬‫‪1‬سال پس از اسپلنکتومی کوله سیستکتومی می شود‬
‫از ‪ 10‬سال قبل تزریق خون نداشته‬‫از ابتدای بارداری تحت درمان با هپارین به صورت ‪ 5000‬واحد ‪ BD‬بوده‬‫است‬
 Gestational age
 BPD ,HC,AC,FL
 TCD
 EFW
 AFI
 Doppler sonography
 BPP
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BPD : 24W
HC : 24W 2D
AC : 24W 1D
FL :23W 3D
EFW : 539 g
AFI : 10cm
Umbilical artery : reversed EDV
Ductus venosus : NL
BPP : 10/10
symmetric IUGR
Associated conditions:
- Genetic
- Congenital anomalies
- Intrauterine infections
- Substance abuse
- Cigarette smoking
- Therapeutic irradiation
 Anomaly scan
 Karyotyping identification : severe early
onset IUGR , Symmetrical IUGR
,polyhydramnious ,stractural anomaly .
 Echocardiography
 Serology :CMV ,RUBELLA , VARICELLA
IUGR
yes
TORCH stigmata  work-up?
no
yes
Dysmorphic features  work-up?
no
yes
Maternal/placental explanation work-up?
no
yes
Maternal drug use tox screen
no
Unknown cause
 Growth curve (biometry)
 Doppler
 BPP
 NST
 Normal doppler & AFI : fortnightly
 umbilical artery end diastolic flow is present :
weekly Doppler
BPP twice weekly
 Absent or reversed end diastolic flow in the
umbilical artery :
hospital admission
daily BPP and Doppler
 FGR < 5 %
 Severe oligohydramnious
 Absent / reverse EDV
 Equivocal BPP ( 6/10 )
Sonography after than 18
days
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BPP : 26w 5d
HC : 25w 6d
AC : 24w 6d
FL : 24w 2d
EFW : 615 g
AFI : 10 cm
Umbilical artery reversed EDV
DV : flow a wave decreased
 GA : 30w 2d
 C/S
 Female : 630 gr
 Fetal acidemia
 Spontaneous late deceleration
 Absent /reverse umbilical artery EDV
40y , G3L2(c/s)
 GA : 35w 1d but by sono 8 weeks : 33w 1d
 FH : 30 cm
 PMH : no problem
 OBH : neg
 US :
BPD : 28w 3d
HC : 28w 3d
AC : 25w
FL : 26w
HL : 24w 5d
EFW : 746g
AFI : 5 cm
doppler: NL
 SGA 24+0 and 35+6 weeks before delivery :
antenatal corticosteroids.
 Magnesium : under 30 week.
 smoking cessation.
 Antithrombotic therapy appears to be a
promising therapy for preventing SGA in
high risk women.However there is
insufficient evidence, especially concerning
serious adverse effects, to recommend
its use.
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BPD : 29W 3D
AC : 26w
FL : 26W 5D
EFW : 767 g
AFI : 2 cm
BPP : 8/10
DOPPLER : NL
BPD : 28w 3d
HC : 28w 3d
AC : 25w (191 mm)
FL : 26w
HL : 24w 5d
EFW : 746g
AFI : 5 cm
 BPD : 29W 3D
 HC : 28w 5d
 AC : 26w (200 mm)
 FL : 26W 5D
 EFW : 767 g
 AFI : 2 cm
 During 16 days : growth arrest .
 GA 35w 3d : C/S
 BW : 825 gr
 29y , G2ab1
 GA : 30w 4d (by sono 13w : 30w 6d )
 FH=26 cm
 PMH : NEG
 DH: heparin
 Sono: GA : 29 w 6 d
BPD=27W 4D
HC : 27W 6D
AC : 25W 4D
FL : 25W 4D
EFW: 765 g
AFI : 67 mm
BPP : 10/10
DOPPLER : NL
 Sono ( GA : 30w 4d)
AFI < 5 cm
BPP=6/8 (breath=0)
 RI MCA/ RI UMA=0.67/0.79
 Hospitalization
Sono ( GA : 31 w 6d )
 AFI < 5 cm
 Doppler : absent EDV in umbilical artery

BPP=10/10
‫‪ After than 15 days‬‬
‫‪ AFI =severe oligohydramnious‬‬
‫‪EFW= 997 gr‬‬
‫‪BPP=8/8‬‬
‫در سن حاملگی ‪ 32‬هفته و ‪ 5‬روز به صورت‬
‫اوژانسی به دلیل پره اکالمپسی شدید‬
‫ترمیناسیون‬
‫انجام شد‬
 Abnormal DV(A/R a wave) or umbillical
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vein(pulsetile) with every GA .
Umbilical artery reverse EDV until 30-32
weeks
Umbilical artery absent EDV until 32-34
weeks
Umbilical artery high RI until 36- 37 weeks
Constitutional IUGR : 37-38 weeks
 Maternal comorbidity
 arrest of growth
 Oligohydramnious
 A/R EDV umbilical artery
 MCA PI < 5%
 BPP < 4
 Recurrent deceleration FHR
 First pregnancy AGA : 9%
 First pregnancy SGA : 29%
 First and second pregnancy SGA : 44%
 cessation of smoking and alcohol intake
 balanced energy/protein supplementation
 Avoiding a short or long interpregnancy
interval
 Low risk : fundal height (exception large myoma
,BMI > 35)
 High risk : ultrasonography
 Biochemical : low PAPP-A , high AFP
 Uterine artery doppler
 Maternal age > 35 yrs
 Nulliparity
 BMI <20
 BMI 25-29.9
 Smoker 1-10 per day
 Pregnancy interval < 6 mo
 Pregnancy interval >30 mo
 Paternal SGA
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Maternal age > 40 yrs
Daily vigorous exercise
Previous SGA baby
Smoker >11 per day
Previous stillbirth
Maternal SGA
Preeclampsia
Maternal Medical disease
Heavy bleeding similar to mense
Echogenic bowel
Low maternal weight
Low PAPP-A
"Advise women at high risk of pre-eclampsia to
take 75 mg of aspirin* daily from 12 weeks until the
birth of the baby. Women at high risk are those
with any of the following:
• hypertensive disease during a previous pregnancy
• chronic kidney disease
• autoimmune disease such as systemic lupus
erythematosis or antiphospholipid syndrome
• type 1 or type 2 diabetes
• chronic hypertension.
Advise women with more than one moderate risk
factor for pre-eclampsia to take 75 mg of aspirin* daily
from 12 weeks until the birth of the baby. Factors
indicating moderate risk are:
• first pregnancy
• age 40 years or older
• pregnancy interval of more than 10 years
• body mass index (BMI) of 35 kg/m² or more at first
visit
• family history of pre-eclampsia
• multiple pregnancy.